By next week, Cincinnati-area doctors are expected to receive notification of a class action settlement with Humana Health Plans of Ohio, under which the plan promises to raise overall reimbursements by 36% in the next three years, or $100 million in added reimbursements.
If sufficient numbers of an estimated 3,500 doctors do not challenge the settlement, the document will be reviewed by Ohio and Kentucky judges in a Dec. 29 fairness hearing, according to the Academy of Medicine of Cincinnati.
If the document is approved, each practice would negotiate a fee increase with Humana, says Russell Dean Jr., executive director of the academy, which filed the original antitrust lawsuit along with several practices.
He adds that the 36% increase is an overall amount that will vary by contract, and what each doctor gets "will come down to each practice's negotiating skills."
Dean says Humana agreed to the settlement on Oct. 23, before a state judge could rule on plaintiffs' request for class action status.
"On the one hand," Dean says, "you could say Humana is really a great corporate citizen for settling this lawsuit. On the other hand you might ask, 'Gee, I wonder what they have to hide?'"
Doctors who agree to the settlement waive their rights to file further antitrust lawsuits against Humana.
The academy and doctors have also sued Aetna, UnitedHealthcare and Anthem for antitrust violations, but those plans have not agreed to a settlement, and their cases also do not have class action status.
A day after the Humana settlement was announced, a Kentucky judge denied the plaintiffs' motion for class certification of the three lawsuits, pending a ruling by the state appeals court, the academy reports.